Cold weather and its effect on aches and pains
We all have come across people who detest winter because it leads to increased amount of aches and pains. As healthcare providers you will see more reporting of deterioration of pain control as winter arrives among those who have arthritic condition or chronic pain of other nature. There are a whole lot of such chronic pain conditions; examples include fibromyalgia, neuralgia, phantom limb pain, polymyalgia rheumatica etc.
There is a theory of change in barometric pressure leading to increase in pain in muscles and joints. Although only subtle changes happen with weather variation but people witch chronic pain condition can feel as real decline in pain management.
Our role includes to recognise this as not just subjective response but equip the sufferers with practical ways to get through winter.
During winter dressing warmly is the key. Paying special attention to the head, hands and feet, as majority of heat is lost from the body's extremities. Some helpful winter dressing tips include:
Wear loose layers when going outdoors. Layers traps body heat to keep you warm.
Wear mittens or gloves to protect your hands.
Wear a hat or beanie to protect your head.
Wear a scarf to protect your neck.
Wear socks and waterproof boots to avoid getting feet wet or damp.
The cold and damp weather can also cause changes to people’s exercise plans. We have an instinct during winter to hibernate; however, a lack of physical activity will cause joints to become stiff. Exercise eases arthritis pain. It increases strength and flexibility, reduces joint pain, and helps combat fatigue. To manage arthritic conditions during the cooler months, individuals need to plan physical activities that are easy to do during winter, such as:
Walking indoors, such as around shopping centres
Household chores, like vacuuming
Playing with children
Swimming indoors, such as Hydrotherapy
Taking an aerobics or yoga class
Listening to music and dancing
Using the stairs instead of the elevator
Stretching or doing light exercises while watching TV
However as healthcare professional if we see a patient with exacerbation of pain during winter, it should not be dismissed as expected deterioration linked with weather changes. If pain is not managed adequately it can lead to long term distress and disability. Therefore should a patient decide to consult a clinician for worsening pain following must be followed
A fresh assessment of severity and quality of pain. (using SOCRATES)
Psychological assessment (scanning for low mood, self-harm, hopelessness etc)
Social impact of chronic pain ( potential loss of earnings, missed education/sports, patient may be a carer and this will affect far more than just one individual )
You may consider involving member s of multidisciplinary team such as physiotherapist, pain clinic, Occupational therapist, mental health etc.
The treatment should not just be aimed at pain relief but also at changing pain behaviour and improving function. The goals of treatment must be realistic and should be focused on restoration of normal function (minimal disability), better quality of life, reduction of use of medication and prevention of relapse of chronic symptom.
It’s of great importance that the patient feels been listened to. At each encounter a reminder about acceptability of chronic pain helps patient stay positive and manage to live as independent life as possible.
As for pharmacological intervention a stepwise approach should be chosen. Analgesics can be broadly classified as:
Topical rubeficient eg. Capsiacin
Oral NSIADs (caution re long term/high dose use)
Starting with weak opioids such as low dose Codeine combined with Paracetamol
Stronger Opioids such as Tramadol, Morphine, Buprenorphine, Oxycodone, Fentanyl etc. Caution : should consider Specialist referral if patient is using equivalent of 180mg/day Morphine. There is dependency and abuse potential due to sedative nature.
Gabapentin and Pregabalin are currently licensed for use in neuropathic pain.
Carbamazepine is first line choice for Trigeminal Neuralgia
Antidepressants for pain relief
Duloxetine is licensed for neuropathic pain
Amitriptyline (although should not be first choice) is also used for neuropathic pain.